Menopause is defined as 12 consecutive months without a period when no other explanation is found. There are so many other symptoms and changes that come with menopause, many begin in mid to late forties and continue until mid to late 50s. However, the ending of the period is the defining characteristic of menopause and the primary way it is definitively given a date.
So what about bleeding after a woman is “menopausal”?
Fortunately, most women with postmenopausal bleeding (PMB) have reasons that are benign: they can be from a thinning of the endometrial lining, from benign anatomic changes and often no reason is found. Over 90% of women with PMB have a benign cause.
What about the rest of them?
A recent study in JAMA has demonstrated that 7-9% of women with PMB have a cancer of their endometrium—the lining on the inside of the uterus. When women do have endometrial cancer, 90% of them will have some PMB.
When women come in for assessment of their PMB, evaluation involves a review of their recent history, medications they are on, and an exam. Other parts of the evaluation may include a transvaginal ultrasound and/or a biopsy of the uterine lining. We are also fortunate to have easy, in office hysteroscopy that can be done without sedation.
The bottom line?
For women with any PMB is to come in. Most likely you will be reassured that there is nothing to do, in some cases you may need treatment for benign conditions, and rarely an endometrial cancer will be found. However, for those women with endometrial cancer, early detection can make all the difference. When caught early, endometrial cancer has a very high cure rate with surgery alone.
El Camino Women’s Medical Group offers the latest Minimally Invasive Solutions for gynecologic problems. Drs. Amy Teng, Erika Balassiano, and Pooja Gupta, all members of AAGL (American Association of Gynecologic Laparoscopy) are highly trained and experienced in the field of Minimally Invasive Gynecgologic Surgery. Dr. Erika Balassiano is also a graduate of the Minimally Invasive Gynecologic Surgery Fellowship at Stanford University, under the supervision of world-renowned Dr. Camran Nezhat.
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